A Closer Look at Mental Health · Booklet 40
What to Do in a Psychological Emergency
In some moments, what is needed is not waiting, but prioritizing safety.
This booklet describes the safe and straightforward steps a person or their loved ones can take in moments of mental health crisis. The aim is not to create panic, but to make it easier to recognize acute risks and reach appropriate help.
Read this text not to draw a quick conclusion, but to look more carefully at yourself and at human relationships. Knowledge points the way, but clinical decisions require context.
In moments of crisis the most fitting thing to say is often this. We will not carry this moment alone. We will put safety first. We will reach help together.
What a psychological emergency is
A psychological emergency is a situation in which the safety of the person or those around them is at short-term risk. This is not limited to suicidal ideation. Psychotic symptoms, severe mania, severe alcohol or substance withdrawal, uncontrolled aggression, serious self-harm behavior, severe eating disorders, intense post-traumatic dissociation, and a person becoming unable to care for themselves can all require emergency assessment.
The goal in a crisis is not to conduct long-term therapy. The first goal is to ensure safety, not leave the person alone, reach the necessary professional help, and reduce access to means of harm.
If there is any possibility of harm to yourself or someone else, contact local emergency health services or the nearest emergency department. Being alone during a crisis can increase risk.
Signs that require immediate help
The person saying they want to kill themselves or making a plan to do so. The beginning or worsening of self-harm behavior. Hearing voices that are not real, a firm belief of being followed, severe suspicion, or detachment from reality.
Not sleeping for several days, excessive energy, agitation, uncontrolled spending, dangerous behaviors, or signs of mania. Trembling, confusion, seizures, hallucinations, or severe physical symptoms following the sudden stopping of alcohol or certain substances. Serious weight loss, fainting, vomiting, dehydration, or an inability to sustain eating behavior. Risk of violence, threats, loss of control, or the need to leave a safe environment. After trauma, the person appearing cut off from their location, the time, or who they are, and being unable to ensure their own safety.
What loved ones can do during a crisis
Be calm, brief, and clear first. Giving long explanations to someone in crisis rarely works. Short sentences such as "I am here with you. We are going to make sure you are safe right now. We will get help together." can be more useful.
Do not leave the person alone. Especially when there is suicidal ideation, self-harm, the influence of substances, severe panic, psychosis, or loss of control, being alone can increase risk. If possible, involve a trusted adult, a family member, or a professional support channel in the process.
Remove means of harm from the environment. This step should be done not with an accusatory attitude but with language that prioritizes safety. "Not because I don't trust you, but so that we can get through this moment safely, let's put this aside together." is a better framing.
Do not get into an argument. Do not try to overcome psychotic beliefs, severe emotional agitation, or suicidal thinking through a contest of logic. In a crisis the goal is not persuasion, it is safety and connection.
If the person expresses suicidal thoughts
Ask directly but calmly. Open questions such as "Are you thinking about hurting yourself?" or "Have you thought about ending your life?" usually do not increase risk. On the contrary, they make visible the thought that the person has been carrying alone.
If the answer is yes, do not promise to keep it a secret. "I will not carry this alone, because your safety matters." is the more honest thing to say. Ensuring the person's safety comes before confidentiality.
If there is a plan, a means, and proximity in time, emergency help is needed. In that situation, stay with the person and make your way to local emergency health services or the nearest emergency department.
The five-step support logic
Ask. Be there. Increase safety. Connect to appropriate help. Then follow up again. NIMH describes this approach as the foundational steps for supporting someone having thoughts of suicide.
What to do after the crisis passes
When the crisis moment has passed, that does not mean everything is over. A crisis is often a sign of a broader problem. For this reason, post-crisis assessment, therapy, a psychiatric consultation, a family meeting, a safety plan, and social support arrangements are all needed.
After a crisis, blaming the person, shaming them, threatening them with "if you do this again", or ignoring what happened entirely all make recovery harder. What is needed instead is a plan that takes what happened seriously, talks about safety, and determines what will be done if it happens again.
The crisis plan should be personal to the individual. The person's triggers, early warning signs, ways of calming down, people to call, safe places to go, and professional support channels should all be identified together.
Questions to ask yourself
- Am I or is my loved one safe right now?
- Would being alone increase the risk?
- Is it possible to reduce the means of harm in the environment?
- Which trusted person or institution can I contact immediately in this situation?
- What kind of safety plan should be made once the crisis has passed?
Source note
This booklet is an original psychoeducational text. Its clinical frame is kept consistent with the sources below.
- NICE. Self harm, assessment, management and preventing recurrence, NG225.
- NHS. Where to get urgent help for mental health.
- WHO. Suicide fact sheet and suicide prevention resources. 2025.
- NIMH. Five action steps for helping someone having thoughts of suicide.